Health & Sanitation

  • Diseases from unsafe water and lack of basic sanitation kill more people every year than all forms of violence, including war. That’s wrong. We all have the right to clean water. Oxfam is providing life-saving clean water, and sanitation and hygiene education in some of the world’s poorest countries, as well as in areas struck by humanitarian crises.

For those who have fled Eastern Ghouta, life now comes with different challenges

by Matthew Hemsley
 
An Oxfam staff member helps a child fill a water bottle from a tank in Herjalleh collective shelter.  Oxfam has been trucking clean water to the site, for the 14,000 Syrians displaced from Eastern Ghouta who are living there. Photo Credit: Dania Kareh
 
Queueing from dawn until mid-afternoon for the chance of a hot meal, living eight people to a small tent, stagnant dirty water risking waterborne diseases as the temperature rises, and a shortage of clean water for washing, eating and cooking… These are just some of the issues raised with me by Syrians forced to flee eastern Ghouta, now living in a collective shelter in Herjalleh, rural Damascus - home to over 14,000 Syrians living either in rooms in small apartment blocks, other living outside the buildings in tents.
 
While the shelter is not as busy as it used to be, with relatives of some women and older men in the shelter able to sponsor them to leave, those running the humanitarian response worry that more families from Douma will soon arrive.
 
One official said, "there could be 20,000 more people coming and the sanitation is already overflowing, it needs to be fixed."
 
Living conditions are already crowded. For those living in apartment blocks, seven to eight sometimes must share a room. Parents and their children too. For people living in tents, it's harder. I spoke to one family of eight living in a small tent.
 
"When we moved here, we lived in the open. Now we have this tarpaulin sheet. We don't know how long we will have to stay here like this. Our homes in Ghouta were destroyed."
 
One family told me they left Ghouta with just the clothes on their backs. They previously kept sheep, but had to leave their livestock, and their livelihood, behind. They have no savings.
 
It's tough for people living out here, and what little money they do have - some offered by relatives trying to help - just doesn't stretch that far.
 
There are shops in the shelter, selling vegetables and other goods, but though the prices are cheaper than they were in Ghouta, it is difficult for people with so little to afford what they need.
 
Warm meals are available, but people must wait in line, sometimes for hours at a time, to get their fair share. This is their everyday life.
 
Maintaining good hygiene is another challenge. A poor drainage and sanitation system means there is dirty water across the shelter, which increases health risks for the people who live here as the days get hotter, and as clean water becomes scarcer. Safety is a concern as well, and for many a simple trip to the installed showers and toilet blocks is a dangerous endeavour during the night hours.
 
But humanitarian agencies are helping improve conditions for civilians. Oxfam is providing clean water by truck to the communal water tower, the kitchen, and directly into tanks serving the apartment blocks. Tap stands are connected to other water sources making clean water available to those who need it. Other agencies, including the UN, are helping too. But more funding is desperately needed. Repairing a sanitation network that is overflowing, for example, doesn't come cheap - but it is lifechanging for the those living here, as well as for the community living in the nearby town.
 
For many people now in Herjalleh, the future looks uncertain. Many say their homes in Ghouta have been destroyed, their livelihoods lost. They have nowhere to go and want to remain in the shelter where at least there is some access to goods and services. Others have no way of knowing what is it that they've lost. But most hope to return to their homes someday. Whether that is a possibility or not remains to be seen.

In South Sudan, Oxfam races the rains to save lives

By Tim Bierley

In the middle of war, even the simple solutions to staying healthy can feel impossible, but education and resources at the community level are saving lives every day.

Nyawal is a community heath volunteer, helping to educate her community about the importance of keeping their community clean, using clean water and practicing good sanitation to avoid diseases like cholera and diarrhea. Right now, Oxfam and volunteers like Nyawal are racing to educate and provide resources before the rainy season starts. Photo: Tim Bierley/Oxfam
 
You can do many simple things to keep control of cholera and diarrhoea, explains Yoal, an Oxfam health volunteer in Pading, South Sudan. But it gets more complicated when your town’s water pumps break down and people are forced to drink swamp water; when animals drink and defecate in the same water sources; when there are no toilets; when you only have one container for bathing, collecting water and washing clothes and dishes; when conflict cuts off your town from almost all trade and the price of soap is more than many people earn in a week; when sick people must walk 30 miles through blistering heat to reach the nearest hospital.

“It is hard for people to keep healthy here,” Yoal sighs. “In 2017, we had so many cases of cholera and diarrhoea. We lost 27 people.”

Yoal, an Oxfam community health volunteer, teaches the importance of keeping water containers clean in Lankien. Photo: Tim Bierley/Oxfam
 
Yoal’s home town of Pading is a small cluster of pointy-topped huts in Nyirol County in the northeast of South Sudan. It is extremely remote – surrounded by huge stretches of almost completely flat land, compressed into uniformity by the swamps which swell in the wet season between May and October. The swamps make delivering aid to places like Pading extremely difficult and they also increase the risk of cholera, as the expanding waters soak and mix up everything in their path.

Soon, those rains will thunder down on Pading again. With lives at stake, Oxfam is racing to make sure communities like this one are prepared with the means to fight off another outbreak during the wet season.

Oxfam and local leaders respond ahead of the rains

Last month, engineers from our mobile emergency response team repaired the town’s two water pumps, so Pading will have clean water this year. Now we’re working with volunteers like Yoal to teach people practical ways to keep disease at bay, as well as handing out supplies like water buckets, containers for bathing, soap and drinking cups.

The key to surviving in extremely risky situations like this, Yoal says, is being completely thorough.

“Sometimes, everyone within the family has to rely on the same containers for lots of different uses,” he says. “You have to be extremely careful about how you use your resources.”

He explains that as the war has dragged on, people have grown increasingly tired. They have seen friends and family die unnecessary deaths. It can be hard to persuade people that it’s possible to stop the slide, when it is clear the conflict is forcing people into ever worsening positions.

“You have to give really practical support like telling people that even if they cannot afford soap for washing, they can use ash. They should boil water if they are drinking it from the swamp. We explain exactly how each thing can affect them.”

Children are the common denominator

Convincing people that change is possible is not still not always easy, but Yoal says there is one thing that unites everyone: “It’s when people see the impact on their children’s health that they are really affected by what I say. Everyone just wants to keep their family safe.”

Nyawal, who volunteers for Oxfam in Lankien, a town nine hours walk from Pading, knows too well the impact cholera can have on a family. She lost two children to the disease last year. Like so many mothers in South Sudan, she felt that their lives were almost out of her control.

Nyawal, smiling with one of her children whose health has improved, is an Oxfam volunteer in Lankien helping with water and sanitation work. Photo: Tim Bierley/Oxfam

“I have always kept things clean and done everything I can to look after my family,” she says, but adds that people across the community do not realise the constant level of vigilance needed to prevent the spread of cholera.

Cholera can spread extremely quickly and through the most innocuous-seeming sources. Nyawal says she always knew that you should wave flies away from your food, for example. It’s instinctive. But she hadn’t seen it as a life and death matter. She doesn’t know what it was that caused her children to fall to cholera, but she wants to make sure her neighbours don’t suffer the same fate.

“As someone who went through this experience I have to keep telling people to take care of themselves and their children – how to help stop these diseases. We’ve brought tools, including rakes and pangas to help people clean up the areas around their houses and we’re telling them how to ensure their food is safe.”

Clean water isn't always an option in a warzone

Just as it is impossible to keep every fly from infecting food, sometimes the conflict takes health completely out of people’s control. Just outside Lankien, William a village elder tells how fighting in the area forced him and his community to flee deep into the bush, fearing attacks on civilians. The priority was to hide, so it was not possible for people to use functioning boreholes in the area: most were close to the road and therefore considered to be too exposed.

Yoal and his family were forced to flee violence and were too afraid to seek out clean water or boil water where they were hiding. Photo: Tim Bierley/Oxfam

“During this time, we had to drink swamp water,” he says. “It was hot and dirty.”

He and his family could not even treat the water by boiling it, as demonstrated by Oxfam’s health volunteers, for fear that the smoke would give away their position, and almost inevitably disease spread.

“A lot of us got sick at this time,” says William. “People lost their lives.”

In a country at conflict, it is extremely hard for communities to eradicate the risk of disease completely. It makes a huge difference to have access to clean water and to the utensils needed to be thorough in hygiene practices, but simple bad luck is also an inevitable factor. The awful fortune of being surrounded by chattering guns is compounded by the resulting destruction of water sources, of trade, of whole ways of life. People continue to be forced from their homes, their routines, and their means of looking after themselves.

As long as this keeps going, thousands of people will continue to suffer from entirely preventable diseases. Oxfam will continue to help people access clean water, maintain their dignity and keep their communities alive. That is something we can at least control.

WASH in the camps

Women collecting drinking water supplied by Oxfam in Kalunga camp, Kalemie, Tanganyika, Democratic Republic of the Congo. Oxfam is providing water, sanitation services and training to keep families healthy. Photo: Diana Zeyneb Alhindawi/Oxfam

In Kalemie province in southeast Democratic Republic of the Congo (DRC), the extreme violence between the Bantu and the Twa ethnic groups and brutal clashes between armed group have very forced more than 654,000 people to flee their homes and thousands of families are facing an increasingly critical food shortage. Women, children and the elderly are among those most affected after having seen families killed, villages burned and fields destroyed. The situation remains volatile and threatens to flare up again at any moment, preventing the displaced from going back to their villages and rebuild their lives.

Oxfam has been working in Kalemie since February 2017 and has already reached 58,302 people forced from their homes and the communities who have welcomed them. Oxfam is helping to provide clean water and sanitation facilities and working with community volunteers to educate people about the importance of good hygiene for staying healthy.

Left: Therese*, a Public Health Promoter talks to a child in Kalunga IDP camp, Kalemie, Tanganyika, Democratic Republic of the Congo. Right: Therese cleans Oxfam sanitation facilities in her community. Photo: Diana Zeyneb Alhindawi/Oxfam.

Therese has been in the Kalunga camp since November 2016. When her village was attacked, she was separated from one of her children and her husband. Therese went looking for them after the attack but couldn't find them, and three months later she was told that their bodies had been found. Therese lives in the Kalunga camp with 9 of her children, ages 7-17 years old. She was trained by Oxfam to be a camp hygiene promoter, and she works daily to clean sanitation facilities in the camp, as well as distributing water purification tablets to families so they have safe water to drink.

Therese said: "We fled as we were. There was no time to pack anything. You only took your children and ran."

"We walked for two days before reaching here. I had so many thoughts in my mind. I had been left with nothing. Sometimes I wish it was me who had died instead of my husband, because this burden is too much for me to bear."

"I have 9 children remaining. One of them is paralyzed and so I had to carry her all the way."

"We reached here in November last year and were received well. We received food for the first two months as well as some money to help us buy other things from the shops. But how can you bring up 9 children in these conditions?"

"People have been talking of going back when the fighting ends. Others are even going there to check on their farms or what is left of their possessions."

"I have experienced war in my life but never have I been forced to leave my home and live in a (IDP) camp. I have never seen fighting like this."

"I never thought I would ever be here. My plan was to save money to build a house where my family could live comfortably and live an ordinary life. But now I can’t even think beyond today. How can I think of a good education for my children if I don’t know where their next meal will come from?"

Oxfam is suppling drinking water to the people in Kalunga camp. Oxfam also trained 61 women from the camp as hygiene promoters. Their daily work includes cleaning sanitation facilities (toilets and bath areas) in the camp, distributing water purification tablets to families.

One woman leading the way for healthy mothers in Bangladesh's refugee camps

By AJM Zobaidur Rahman, Campaigns and Communications Officer, Oxfam in Bangladesh

Rajiah, sitting here in her home in Cox's Bazar, Bangladesh, is a community health volunteer who helps share health information with pregnant refugee women. Photo Credit: OXFAM

Rajiah, 46, fled violence near her home in Myanmar 6 months ago, with her younger daughter, who is 15 years old. She is now living in a refugee camp in Bangladesh with thousand other Rohingya. Rajiah is one of close to a million Rohingya people have fled violence in Myanmar to seek refuge across the border in Bangladesh. This unprecedented number of refugees, of whom more than half are children, has caused a large-scale humanitarian crisis.

Left: Rajiah sharing health information with a pregnant woman in her home in Cox's Bazar, Bangladesh. Right: Rajiah walking through the refugee camp to visit her pregnant neighbor in Cox's Bazar, Bangladesh. Photo Credit: OXFAM

WOMEN HELPING WOMEN SURVIVE AND THRIVE

Rajiah has been surrounded by women throughout her life as the eldest of 10 sisters. She herself has 5 daughters, two of which are also in camps living as refugees in Bangladesh with their husbands, while the other two remain in Myanmar. Tragically, Rajiah’s husband disappeared when the violence broke out in Myanmar and Rajiah has no way of knowing where he is. Like so many women in the camp, Rajiah must head up her household alone.

Oxfam has come to know Rajiah as a leader when she was unanimously selected to represent her community during an Oxfam assessment of what their most pressing needs were. Rajiah is well educated and has been working with and for her community throughout her life. She told us that she delivered some 10,000 babies as a midwife in Myanmar.

Now, as a refugee in Bangladesh, she is making sure she puts her experience to good use and supports and provides information to the pregnant women in her community. Her name means “Hope” - a true reflection of her personality and life’s work.

Left: Rajiah and her younger daughter inside her house in the refugee camp. Right: Rajiah taking notes about International Women's Day. Photo Credit: OXFAM

RAJIAH BRINGS LEADERSHIP TO COX'S BAZAR

Rajiah was born in a relatively affluent family in Myanmar. Education was an important part of her childhood, and her family made sure all the girls had 8 years of schooling. Rajiah speaks particularly highly of her father, who she says was the greatest influence in her life.

Rajiah honed her leadership skills from a young age, starting at school as a class leader. Later, organizations who were working in her community, including the UN, selected Rajiah as one of their volunteers. She continued working as a health worker and played a major role in the vaccination process in her area, helping to prevent children dying needlessly from preventable illnesses.

Rajiah is outspoken and confident, a full believer in women’s role outside the household. That way, she says, women can get knowledge and they can advance – and then other women can also come forward simply by seeing these role models. She is very keen on working and further helping her community, especially the women in her community.

OXFAM IS THERE

Oxfam is planning to organize women’s groups in the camps and Rajiah is the ideal person to lead this process in her community. With her leadership skills, kind and warm personality, she will undoubtedly make great progress with the women in the community. Oxfam is also currently focusing on providing water and sanitation and adapting to better deal with the crowded conditions and sheer numbers of people. We are drilling wells and installing water points, toilets and showers. We’re also helping people stay healthy and hygienic by distributing soap and other essentials and working with community-based volunteers to emphasize the importance of clean water and good hygiene, especially as monsoon season approaches. So far, we have reached at least 185,000 people, and hope to reach more than 250,000 in the coming months.

Donate now to help those in refugees camps in Bangladesh

Stop the war in Yemen

In a camp for people forced to flee their homes due to the war in Abs district, Hajjah governorate, Ahmed lives with his younger brother and three sisters. He is only 14 but has a thousand reasons to end this inhuman war. His father was diagnosed with cancer, his house was bombed and his sheep, the family's main source of income, died. Thankfully the family survived and moved out to this camp in Abs.

Left & Right: Ahmed and his siblings in Al-Okasha IDP camp, Abs district, Hajjah governorate - Credit: Ahmed Al-Fadeel / Oxfam Yemen.

The story doesn't end here, even though I wish it did. That would have been considered a happy ending compared to what actually happened. Earlier this year, and after seven months of suffering, Ahmed's father died, leaving his family behind to face poverty alone.

Days without food

Shortly after his father’s death, Ahmed was awakened by his sisters crying around their mother's body. Ahmed rushed into the room just to realize his mother had died. After burying her, they all moved to live with their uncle, who later sent them back to the camp because he couldn't afford to take care of them along with his own large family.

Ahmed suffers from asthma and works to provide food and clothes for his siblings. He tries to work with any opportunity he can find, people give him whatever they call, sometimes a few dollars, most of the time nothing. His sister also collects firewood that he sells on the market in exchange for food. It happens that they spend days without food.

Famine threatens

Famine is threatening eight million people across Yemen, and much of the country’s basic infrastructure has been bombed, including hospitals, schools, water-sources, factories, markets, bridges and ports.

Civil workers haven't been paid their salaries for over a year now, and the UN appeal for Yemen hasn't been fully funded for the third consecutive year, while vital life-saving ports are blocked for more than what people could afford.

Today in 2018, millions of people in Yemen are neglected and suffering, slowly battling starvation and disease. Our people have been bombed, killed, injured, scared, displaced, starved, blocked, sickened, and denied basic rights for nearly three years now.

All of this has happened in front of the very nations that promised to protect human rights. It has happened under the watch of the United Nations and, painfully, many international NGOs who are here with us, struggling on a daily basis to provide help, either because we’re denied access to local districts or because of the blockade of Yemen’s vital life-saving ports.

Left: A displaced woman in Taiz governorate. Zeyad Ghanem / Oxfam Yemen

Oxfam is there

Through Oxfam, we have seen ugly truths that the world is silent about. We have seen death in people's eyes, bodies too hungry to live and malnourished small children suffering from cholera. We don't need to tell you what else we saw, because history is full of examples of war tragedies, some of which are still happening here in Yemen. More than 5,500 civilians have died in this war and over 2,000 others have died of cholera, mostly children and the elderly.

Since July 2015, Oxfam has reached more than 2.8 million people with humanitarian assistance, with the help of our local partners. Yet over 22 million people are in dire need of immediate humanitarian assistance.

World leaders are silent

And still, while the situation keeps on deteriorating, the war is being fueled by arm sales that kill my people. World leaders silently continue to watch what many call the world’s worst humanitarian crisis, and Yemen is facing a world-class humanitarian despair.

World leaders and the United Nations are failing humanity once again. We are disappointed and so are 29 million other Yemenis.

I desperately wish to see the war end and no more children to suffer like Ahmed. There are far too many families like Ahmed's.

Ibrahim Yahia Alwazir, Social Media Officer and Ahmed Al-Fadeel, Field Media Assistant

Pages